Trans Enteric Rendezvous ERCP in a Patient with Loop Duodenal Switch.

Introduction: Performing endoscopic retrograde cholangiopancreatography (ERCP) in duodenal switch (DS) patients is challenging given their surgically altered anatomy. There have been very few reported cases of trans enteric rendezvous ERCP to relieve biliary obstruction in DS patients. More specifically, there has not been any reported cases of this procedure being performed in loop DS, also known as SADI (single anastomosis duodeno-ileostomy) or SIPS (stomach intestinal pylorus sparing procedure). Case Description: This case reports describes a 50-year-old male with prior loop DS who presented with gallstone pancreatitis. He underwent a laparoscopic cholecystectomy with positive intraoperative cholangiogram requiring the need for trans enteric rendezvous ERCP. Discussion: Although never reported, trans enteric rendezvous ERCP is a feasible approach in relieving biliary obstruction in patients with loop DS anatomy.

Regular performance feedback may be key to maintain good quality DKA management: results from a five-year study.

Objectives: We postulate that performance feedback is a prerequisite to ensure sustained improvement in diabetic ketoacidosis (DKA) management. Design: The study was based on 'theory of change' concept that suggests changes of primary drivers determine the main outcome. A set of secondary drivers can be implemented to achieve improvements in these primary drivers and thus the main outcome. Setting: This study was conducted at a large tertiary care center in the West Midlands, UK. The region has above average prevalence of diabetes and DKA admissions in the country. Participants: All participants diagnosed with DKA as per national guidelines, except those managed in intensive care unit from April 2014 to March 2018, were included in this study. Interventions: Monthly feedback of performance was the main intervention. Development of a real-time live DKA audit tool, automatic referral system of DKA to the specialist team, electronic monitoring of blood gas measurements and education and redesigning of local (trust) guidelines were the other interventions in this study. Main outcome measures: Total DKA duration, appropriateness of fixed rate intravenous insulin infusion, fluid prescription, glucose monitoring, ketone monitoring and referral to specialists. Results: There was a significant reduction in the duration of DKA postintervention compared with baseline results. However, in the absence of regular feedback, the duration of DKA showed an upward trend nearing baseline values. Similar trends were noted in secondary drivers influencing DKA duration. Conclusion: Based on these results, we recommend regular audit and feedback is required to sustain improvements in DKA management.

Twisted tethered tolanes: unanticipated long-lived phosphorescence at 77 K.

Influencing the communication within a conjugated system as diphenylacetylene is a challenging subject in molecular electronics. Some examples of twisted tolanes are known, where high twists have been achieved in the solid state by steric encumbrance. The insertion of a spacer system is an alternative way to tailor rotation. Only a few examples of such tethered tolanes exist, and they all suffer from small twist angles (<35°). We report on tolanophanes containing a malonyl tether, where twist angles of almost 80° were reached. Long-lived phosphorescence (4 s at 77 K) was recorded, and quantum-chemical calculations were performed to confirm the experimental results.

From thia- to selenadiazoles: changing interaction priority.

The synthesis, optical, and electrochemical properties as well as solid-state structures of a series of alkynylated, benzannulated selenadiazoles are reported. This set of compounds is compared to the lighter homologue series, the thiadiazoles. The selenadiazoles show head-to-head dimerization in the solid state, while packing of the thiadiazoles was dominated by the steric bulk of the side groups. The Se-N interaction is a supramolecular motif that should drive the effective self-assembly and modulate charge transport when these compounds are used as thin films in devices.

Imine formation as a simple reaction to construct copper-reactive cruciform fluorophores.

We developed a series of new conjugated cruciform fluorophores (XF) featuring imine groups. The condensation of an XF containing aldehyde functionalities and selected primary amines leads to several XF-imine derivatives. Upon addition of Cu(2+) or Zn(2+) ions to solutions of the imine XFs in different solvents, a red-shifted emission is detected, resulting in an altered emission color. The imine acts as a simple modular metallo-reactive fluorophore.

Synthesis, excited state dynamics, and optical characteristics of oligophenyl-based swivel cruciforms in solution and solid state.

Oligophenyl-based swivel cruciforms are an amorphous class of materials for potential use in display applications. In this work, we describe the design, synthesis, and structural and optical properties of a group of chromophores with varying degrees of π-conjugation that produce blue emission and high photoluminescence quantum yields (PLQYs). The swivel cruciforms are branched complexes consisting of two arms, and the relative rotation of these arms is an important factor that determines the optical properties of these systems. The studies reveal that the physical size of the system, that is, the arms, and the presence and position of functional groups results in different degrees of sterical effects. This has a dramatic impact on the interplay between nonradiative and radiative decay of the excited state. For the least π-extended system, control of the excited state decay can be achieved by modifying the properties of the medium through an increase in the viscosity, which is demonstrated accordingly. The data shows that an intramolecular excited state is responsible for the swivel cruciform emission in solution. The character of this "aggregate" and its emission is not dissimilar to an excimer, and we therefore attribute it to an intramolecular excimer. In the solid state, a combination of intra- and intermolecular excimers are the most likely source of the emission. The data also shows that intra molecular excimers can produce a surprisingly high PLQY, when either properties of the medium facilitate this or when functional groups introduce steric hindrance, which subsequently prevents the nonraditive decay through conformational change.